Something a patient might notice when they’re talking with Dr. Michael Rieser is his computer. It might, for instance, be filling itself with words – the patient’s own words – recorded, transcribed and saved to the patient’s file automatically. Dr. Rieser, a psychiatrist working in Lexington, Kentucky, has always been interested in technology that can help him provide better patient care and it’s evident in his practice. Now he is using it to better manage medications as well.
Dr. Rieser is board-certified in child and adolescent psychiatry, adult psychiatry and emergency medicine. He works as the medical director at the Ridge Behavioral Health System, a 110-bed practice in Lexington that consists of a mix of psychiatrists and internists who perform in-patient, multi-unit services. It can get very busy. “We get patients from all over Kentucky at this hospital,” said Dr. Rieser.
One of the biggest challenges Ridge Behavioral Health deals with is the high number of medications newly admitted patients are taking. “Some of those patients may come in with 25 or 30 medications.” This can be dangerous since a patient’s chance for adverse drug effects rises with each medication they take. Luckily, there are clinical decision support tools to help avoid these problems, like YouScript®. Dr. Rieser’s been one of the hospital’s biggest proponents of these technologies. “They’ve got computers littered all over the hospital so I can go anywhere and run it. People are used to seeing me use it.”
Improving Patient Health
Dr. Rieser started using YouScript in 2011. “When I started using it, I was so overwhelmed with how many drug interactions there were. You pick up some of these toxic antidepressant effects, it’s really common… Now, even the short regimens, just a couple of medications, I check them in YouScript.”
Dr. Rieser’s interest in medication management came to a head with one particular case. A boy, about 12, was admitted as psychotic. His history included ADHD, then later bipolar disorder, both of which came with various medications. As a routine part of his care, Dr. Rieser put the patient’s drug list into YouScript. “When I punched it in, something jumped out at me.” The child had been prescribed both Prozac® and dextroamphetamine concurrently. “The Prozac inhibited the metabolism of the dextroamphetamine and doubled the blood level,” Dr. Rieser explained, “so the kid was basically amphetamine toxic and not sleeping. I’d get psychotic too.” The root cause of the kid’s psychosis was in his drug regimen, not his brain. Dr. Rieser decreased the child’s dose of dextroamphetamine and the patient recovered.
Patients and other prescribers seem interested in the program, although they’re sometimes hesitant to adopt it themselves. This isn’t uncommon, as implementing new workflow procedures often take time. Nevertheless, Dr. Rieser feels that most prescribers will come around.
“This technology is a little bit like what happened when physicians were being exposed to X-ray reports for the first time. You get to see stuff you’ve never seen before, and you end up seeing stuff you never would have imagined would have been there. It has a big impact on your decision -making.”